Provider Demographics
NPI:1043444359
Name:EUGENE KAPLAN, MD A MEDICAL CORPORATION
Entity type:Organization
Organization Name:EUGENE KAPLAN, MD A MEDICAL CORPORATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:IRENA
Authorized Official - Middle Name:
Authorized Official - Last Name:KAPLAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:925-979-9969
Mailing Address - Street 1:120 LA CASA VIA
Mailing Address - Street 2:SUITE 209
Mailing Address - City:WALNUT CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:94598-3007
Mailing Address - Country:US
Mailing Address - Phone:925-979-9969
Mailing Address - Fax:925-979-9979
Practice Address - Street 1:120 LA CASA VIA
Practice Address - Street 2:SUITE 209
Practice Address - City:WALNUT CREEK
Practice Address - State:CA
Practice Address - Zip Code:94598-3007
Practice Address - Country:US
Practice Address - Phone:925-979-9969
Practice Address - Fax:925-979-9979
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-14
Last Update Date:2011-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA672920174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A672920Medicaid
CAG44885Medicare UPIN